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REV~ 1500 EX + (6-00)
OFFICIAL USE ONLY
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REV-1500
INHERITANCE TAX RETURN FILE NUMBER
RESIDENT DECEDENT ~}CODE 0.:
SOCIAL SECURITY NUMBER
51/
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
BARNHART SR. DONALD W.
DATEOF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
NUMBER
171-28-7358
THIS RETURN MUST BE FILED IN DUPUCATEWlTH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
X 1. Original Return
4. Limited Estate
6. Decedent Died Testate
2. Supplemental Return
4a. Future Interest Compromise (date of death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach copy of Trust)
3 (date of death
. Remainder Return prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
(Attach copy of Will)
o 9. litigation Proceeds Received
010. Spousal Poverty Credit D 11. EJection to tax under Sec. 9113(Aj
(date of death between 12-31-91 and 1-1-95) (Attach Sch 0)
THIS SECTIO.N.Y!JS"t BE COMPLEtEn.l\IloiCQl'lFIESPO"OENCElh~oHFII)EN:rIAL l'AXINFORMATfoN SHOULD. BE DIRECTED TO:
NAME COMPLETE MAJLlNG ADDRESS
Ro er B. Irwin Es
FIRM NAME (If Applicable)
IRWIN & McKNIGHT
TELEPHONE NUMBER
60 West Pomfret Street
West Pomfret Professional Bldg.
Carlisle, PA 17013
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71 249- 3
1. Real Estate (Schedule A) (1) None
2. Stocks and Bonds (Schedule B) (2) None
3. Closely Held Corporation, Partnership or (3) None
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D) (4) None
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 3 t 594.23
(Schedule E)
6. Jointly Owned Property (Schedule F) (6) None
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7) (8)
9. Funeral Expenses & Administrative Costs (Schedule H) (9) 7 t 653.50
10. Debts of Decedent. Mortgage Liabil.ies. & Liens (Schedule I) (10) 5,446.89
11. Total Deductions (total Lines 9 & 10) (11)
12. Net Value of Estate (Line B minus Line 11) (12)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Sub.ect to Tax (Line 12 minus line 13) (14)
C-....,)
(.,..)
,..,.~~
OFF1CIAI.FUSE ONLY
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1...,:::)
-..,,~
C'.)
3,594.23
13.100.39
(9,506.16)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(9,506.16)
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.
x
X
X
X
.0 0
.045
.12
.15
(15)
(16)
(17)
(18)
(19)
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Copyright (c) 2000 form software only The Lackner Group, Inc.
FormREV-1500 EX (Rev. 6~OO)
Decedent's Complete Address:
STREET ADDRESS
924 Burr Avenue
CITY I STATE I ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
Total Credits ( A + B + C) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3. enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
0.00
0.00
0.00
:[iii:i:ii::!i!!ililli!!!i!!li!:!!:.il!.!:!!"iiliiif!1i;illill!]1!!!:I!I!:!!!I!!::!:II:::!!:!I!!!!':!!::I:!'1!!!!!!!III!mlljlm!:!lmmmmlj:!!!III!I!!III!II!I!:::II:!I~!ill:!iiiiiilm!mmimll!llliiliimmiimmlmiill!i
. PLEASE ANSWER THE FOLLOWllilGQUESTIONs BY PLACING AN
1.
1!:mmm
',";)"(;,"
~~!!!f~!~:::;J~:~~~~:::Xf~;~t6g~~ .
Yes No
~~
Did decedent make a transfer and:
a.. retain the use or income of the property transferred: . . . . . . . . . . . .
b. retain the right to designate who shall use the property transferred or its income: .
c, retain a reversionary interest; or . ......
d. receive the promise for life of either payments, benefits or care? . . . .. . . . . . . . . .
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .
3. Did decedent own an ~in trust for" or payable upon death bank account or security at his
or her death?
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property
which contains a beneficiary designation?
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
D
D
D
[i]
[i]
[i]
Under penalties of perjury ,I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true.
correct and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE INGRETURN Michael L. Barnart
;r~A~ -~-~h~~~~~t~~;~PA--J:i266---------------------
IRWIN & McKNIGHT
60 West Pomfret Street
- - -c';'~J:isie;- PA- - i'i61'3- - - - - u - - - - - - - - - - - - - - - - - - --
DATE
6(fft>
SIGNATURE OF PREPARER OTHER THAJJ REPRESENTATIVE
--So aL-
For dates of dea or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. 9116 (a) (1.1) 0)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. 9116 (a) (1. 1) (i0]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets
and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent. an adoptive parent. or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)j.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116( 1.2)
[72 P.S. 91 16(aX 1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(a){1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent. whether by blood or adoption.
Copyright (c) 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
REV-1511 EX +(1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
DONALD W. BARNHART SR.
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
B.
1.
2.
3.
FILE NUMBER
SSf! 171-28-7358
04/05/2005
DESCRIPTION
AMOUNT
1
FUNERAL EXPENSES,
Hollinger Funeral Home - Funeral
6,833.50
ADMINISTRATIVE COSTS,
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year{s) Commission Paid:
Attorney's Fees IRWIN & McKNIGHT
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
500.00
City
Relationship of Claimant to Decedent
State
Zip
4. Probate Fees
6.
5. Accountant's Fees
7.
1
Tax Return Preparer's Fees
250.00
Other Administrative Costs
Roy D. Gottshall - Appraisal on Personal Property
70.00
TOTAL (Also enter on line 9, Recapitulation) S 7,653.50
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97\
REV-1512 EX... (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DONALD W. BARNHART SR.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
FILE NUMBER
SS11 171- 28 - 7358
04/05/2005
Include unreimbursed medical expenses.
ITEM
NUMBER
1
DESCRIPTION
American General - Account #1498 13508072 - Held Jointly With
Elizabeth E. Lange
AMOUNT
634.37
2
Circuit City
Credit Card
2,167.05
3
Lowes - Credit Card
2,645.47
TOTAL (Also enter on line 10, Recapitulation) S
(If more space is needed, insert additional sheets of the same size)
5,446.89
r...."'".i..ht {,,\ 1QQ" f...r.... ",,,,ft,.,:>... nnlv "'~C::v<::t........ I.....,
Form REV-1512 EX (Rev. 1-97\
REV-1513 EX +(9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
DONALD W. BARNHART SR.
FILE NUMBER
SS11 171- 28 - 7358
04/05/2005
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
NUMBER
I.
1
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec. 9116(a)(1.2)j
Donald L. Barnhart
11 Hanunond Road
Walnut Bottom, PA 17266
Son
1/3 Remainder
2
Donald W. Barnhart,
367 Whiskey Springs
Boiling Springs, PA
Jr.
Road
17007
Son
1/3 Remainder
3
Timothy R. Barnhart
1483 Goodyear Road
Gardners, PA 17324
Son
1/3 Remainder
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18. AS APPROPRIATE. ON REV 1500 COVER SHEET
II. NON- TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
CopyrIght (c) 2000 form software only The Lackner Group, Inc.
0.00
Form REV-1513 EX (Rev. 9-00)
rlIM&rBank
499 Mitchell Road, Millsboro, DE 19966 Mail Code DE.MB-12
Phone (888) 502-4349
Fax (302) 934-2955
Aprill3,2005
Law Offices
Irwin & McKnight
West Pomfret Professional Building
60 West Pomfret Street
Carlisle, Pennsylvania 17013-3222
~~~@:uw~~
,JR 2 1 2005
[R \VTN & McKNIGHT
Re: Estate of Donald W Barnhart Sr
Social Security: 171-28-7358
Date of Death: Avril 05, 2005
Dear Sir or Madam:
Per your inquiry dated April 12, 2005, please be advised that at the time of death, the above-named decedent had on deposit
with this bank the following:
I. Type of Account Checking Account
Account Number /I 18005
Ownership (Names oj) Donald W Barnhart Sr *
Opening Date /1/25/91
Balance on Date of Death $2,268.47
Accrued Interest $ 0.00
._____.._"__._..___u_._._,..~".__"'. .'.--....--...-...---
Total $2,268.47
Please be advised, there was no safe deposit box found for the above decedent.
* For further account information, regarding ownership, closures and/or reimbursement of funds, etc., please call
the Mt Holly Springs Omce# 717-486-3038.
Sincerely,
---:r~/ -d(:';?!:>-:f."~
-\ - ,...v 7"'-7 t:/ .. f7
Nancy Clagett
Records Management
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